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Association between metformin use and below-the-knee arterial calcification score in type 2 diabetic patients

BACKGROUND: Vascular calcification (VC) is common in type 2 diabetes, and is associated with cardiovascular complications. Recent preclinical data suggest that metformin inhibits VC both in vitro and in animal models. However, metformin’s effects in patients with diabetic VC have not previously been...

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Autores principales: Mary, Aurélien, Hartemann, Agnes, Liabeuf, Sophie, Aubert, Carole Elodie, Kemel, Salim, Salem, Joe Elie, Cluzel, Philippe, Lenglet, Aurélie, Massy, Ziad A., Lalau, Jean-Daniel, Mentaverri, Romuald, Bourron, Olivier, Kamel, Saïd
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5311847/
https://www.ncbi.nlm.nih.gov/pubmed/28202017
http://dx.doi.org/10.1186/s12933-017-0509-7
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author Mary, Aurélien
Hartemann, Agnes
Liabeuf, Sophie
Aubert, Carole Elodie
Kemel, Salim
Salem, Joe Elie
Cluzel, Philippe
Lenglet, Aurélie
Massy, Ziad A.
Lalau, Jean-Daniel
Mentaverri, Romuald
Bourron, Olivier
Kamel, Saïd
author_facet Mary, Aurélien
Hartemann, Agnes
Liabeuf, Sophie
Aubert, Carole Elodie
Kemel, Salim
Salem, Joe Elie
Cluzel, Philippe
Lenglet, Aurélie
Massy, Ziad A.
Lalau, Jean-Daniel
Mentaverri, Romuald
Bourron, Olivier
Kamel, Saïd
author_sort Mary, Aurélien
collection PubMed
description BACKGROUND: Vascular calcification (VC) is common in type 2 diabetes, and is associated with cardiovascular complications. Recent preclinical data suggest that metformin inhibits VC both in vitro and in animal models. However, metformin’s effects in patients with diabetic VC have not previously been characterized. The present study investigated the association between metformin use and lower-limb arterial calcification in patients with type 2 diabetes and high cardiovascular risk. METHODS: The DIACART cross-sectional cohort study included 198 patients with type 2 diabetes but without severe chronic kidney disease. Below-the-knee calcification scores were assessed by computed tomography and supplemented by colour duplex ultrasonography. Data on anti-diabetic drugs were carefully collected from the patients’ medical records and during patient interviews. Biochemical and clinical data were studied as potential confounding factors. RESULTS: Metformin-treated patients had a significantly lower calcification score than metformin-free patients (mean ± standard deviation: 2033 ± 4514 and 4684 ± 9291, respectively; p = 0.01). A univariate analysis showed that metformin was associated with a significantly lower prevalence of severe below-the-knee arterial calcification (p = 0.02). VC was not significantly associated with the use of other antidiabetic drugs, including sulfonylureas, insulin, gliptin, and glucagon like peptide-1 analogues. A multivariate logistic regression analysis indicated that the association between metformin use and calcification score (odds ratio [95% confidence interval] = 0.33 [0.11–0.98]; p = 0.045) was independent of age, gender, tobacco use, renal function, previous cardiovascular disease, diabetes duration, neuropathy, retinopathy, HbA(1c) levels, and inflammation. CONCLUSIONS: In patients with type 2 diabetes, metformin use was independently associated with a lower below-the-knee arterial calcification score. This association may contribute to metformin’s well-known vascular protective effect. Further prospective investigations of metformin’s potential ability to inhibit VC in patients with and without type 2 diabetes are now needed to confirm these results.
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spelling pubmed-53118472017-02-22 Association between metformin use and below-the-knee arterial calcification score in type 2 diabetic patients Mary, Aurélien Hartemann, Agnes Liabeuf, Sophie Aubert, Carole Elodie Kemel, Salim Salem, Joe Elie Cluzel, Philippe Lenglet, Aurélie Massy, Ziad A. Lalau, Jean-Daniel Mentaverri, Romuald Bourron, Olivier Kamel, Saïd Cardiovasc Diabetol Original Article BACKGROUND: Vascular calcification (VC) is common in type 2 diabetes, and is associated with cardiovascular complications. Recent preclinical data suggest that metformin inhibits VC both in vitro and in animal models. However, metformin’s effects in patients with diabetic VC have not previously been characterized. The present study investigated the association between metformin use and lower-limb arterial calcification in patients with type 2 diabetes and high cardiovascular risk. METHODS: The DIACART cross-sectional cohort study included 198 patients with type 2 diabetes but without severe chronic kidney disease. Below-the-knee calcification scores were assessed by computed tomography and supplemented by colour duplex ultrasonography. Data on anti-diabetic drugs were carefully collected from the patients’ medical records and during patient interviews. Biochemical and clinical data were studied as potential confounding factors. RESULTS: Metformin-treated patients had a significantly lower calcification score than metformin-free patients (mean ± standard deviation: 2033 ± 4514 and 4684 ± 9291, respectively; p = 0.01). A univariate analysis showed that metformin was associated with a significantly lower prevalence of severe below-the-knee arterial calcification (p = 0.02). VC was not significantly associated with the use of other antidiabetic drugs, including sulfonylureas, insulin, gliptin, and glucagon like peptide-1 analogues. A multivariate logistic regression analysis indicated that the association between metformin use and calcification score (odds ratio [95% confidence interval] = 0.33 [0.11–0.98]; p = 0.045) was independent of age, gender, tobacco use, renal function, previous cardiovascular disease, diabetes duration, neuropathy, retinopathy, HbA(1c) levels, and inflammation. CONCLUSIONS: In patients with type 2 diabetes, metformin use was independently associated with a lower below-the-knee arterial calcification score. This association may contribute to metformin’s well-known vascular protective effect. Further prospective investigations of metformin’s potential ability to inhibit VC in patients with and without type 2 diabetes are now needed to confirm these results. BioMed Central 2017-02-15 /pmc/articles/PMC5311847/ /pubmed/28202017 http://dx.doi.org/10.1186/s12933-017-0509-7 Text en © The Author(s) 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Original Article
Mary, Aurélien
Hartemann, Agnes
Liabeuf, Sophie
Aubert, Carole Elodie
Kemel, Salim
Salem, Joe Elie
Cluzel, Philippe
Lenglet, Aurélie
Massy, Ziad A.
Lalau, Jean-Daniel
Mentaverri, Romuald
Bourron, Olivier
Kamel, Saïd
Association between metformin use and below-the-knee arterial calcification score in type 2 diabetic patients
title Association between metformin use and below-the-knee arterial calcification score in type 2 diabetic patients
title_full Association between metformin use and below-the-knee arterial calcification score in type 2 diabetic patients
title_fullStr Association between metformin use and below-the-knee arterial calcification score in type 2 diabetic patients
title_full_unstemmed Association between metformin use and below-the-knee arterial calcification score in type 2 diabetic patients
title_short Association between metformin use and below-the-knee arterial calcification score in type 2 diabetic patients
title_sort association between metformin use and below-the-knee arterial calcification score in type 2 diabetic patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5311847/
https://www.ncbi.nlm.nih.gov/pubmed/28202017
http://dx.doi.org/10.1186/s12933-017-0509-7
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